Nursing 1000 Final

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Nursing Profession What is the NLN?: Nursing organization open to anyone interested in the field
Provides voluntary accredidation for educational programs in nursing
Sponsors continuing Ed credits
Primary source of research data about nursing education
Nursing Profession What is the ANA?: ANA is the American Nurses Association
Only for Nurses/LPN/AN
Establishes Standard in nursing
Encourages research to advance nursing education
Represents nursing in the Law
Supports NSNA=National Student Nurses Association
Legal issues What are the six areas of negligence?: Failure to follow stardard of care
Failure to use equipment in a responsible way
Failure to communicate
Failure to document
Failure to assess and monitor
Failure to act as a patient advocate
Legal Issues What is nonmalefience?: It is the duty to do no harm
Legal issues What is the student nurse responsible for?: they are responsible for their own actions and liable for their own acts of negligence during their clinical experiences. They are held to the same standards of skill and competence as a regerstered nurse
Vital Signs When taking a rectal temperature the patient will experiance tachycardia or bradycardia?: Bradycardia
Intro to Nursing Clara Barton was.....: Red Cross founder/Self-educated
Intro to Nursing The dark ages of nursing were...: 16th century to 1850
It was the decline in Religious orders
Siri Gamp character in Dickens Novel
Intro to Nursing Margaret Sanger was....: individual who was considered the mother of Birth Control. She had the first birth control clinic in NYC 1916
Intro to nursing Definition of Nursing from the ANA 1995: holistic
what we see, what we hear and what the patient telss us
application of scientific knowledge
acknolwledges scientific research for it to be a profession
acknowledges caring
Into to nursing What is the aim and scope of Nursing?: education
caregiver
researcher
patient advocate
counselor
communicator
Legal issues What 4 things prove malpractice?: Duty
Breech of Duty
Causation (caused injury)
Harm resulted
Legal issues What are ethics? What are values?: Ethics are society standards

Values are your own personal beliefs
Preventing Ulcers: Identify at risk patients
Assess skin Areas
Turn Client to prevent shearing
Good Hygeine to prevent infection
Good nutrition, hydration
Protect the client's skin- barrier cream
Early Intervention if ulcer is present
Head of Bed<30 to prevent sliding
heels of bed-posey boots
Types of immunity: Active-antigens enter and body responds
Passive-antibodies exist but were not produced by that person
Active Natural Immunity: conected with illness
most effective and long lasting
Active Artificial Immunity: immunizations, may need boost
Passive Natural Immunity: breast milk, placenta, eliminated when recognized as non-self
Active Passive Immunity: need to avoid serious illness after exposure...rabies...venom
Stages of Infection: incubation:time between pathogen invading and symptoms appearing...may be 1-2 hours up to several years

prodromal: early signs and symptons appears most infectious

Full illness: symptoms very specific to illness/microorganism..may be localized,or systemic

convalescence-signs and symptoms start to wane..recovery begins
Means of transmission of bacteria:: indirect- vehicles contaminated blood, H20 or utensils
Vectors-insects, fleas
2 types of Asepsis: medical: clean technique..reduce number of microorganisms and prevent spread

Surgical: Sterile technique, eliminate all microorganisms from an area
Cardinal signs of inflammatory response: pain
swelling, edema, and fluid accumulation
local heat..increased blood flow
erythema-redness
reduction of function due to pain and swelling

Normal response to surgery...including low grade fever
Wound Healing Primary: incision, well approximated, no gaping edges match, heals in 4 to 14 days, depending on depth
Wound Healing Secondary: some tissue loss, higher infection risk, longer time to heal, scars are likely
Wound Healing Tertiary: time laps between injury and suture
greater risk of infection
Inflamation is the first phase of wound healing...it is from day 1 to day 4 4 stages are:: 1. vasoconstriction: very brief
2.vasodialation: blood to area, cleans debris, dilutes bacteria
3.phagocytosis: wbc get rid of debris-client slightly lethargic, low fever
reanastamosis-blood vessels begin to reconnect
Factors affecting wound healing: Age

Circulatory problems

Oxygenation (smokers have co2 binds w/hemoglobin and replaces O2)

Nutrition-especially need for protein

Wound condition-size

Bacterial load-exudate

Necrotic tissue

Nsaids intfere-stop inflammatory response
Wound Drainage Serous: clear or light yellow, thin and watery
Wound Drainage Sanguinous: Red (fresh blood), thin
Wound Drainage serosanguinous: pink, or light red thin and watery
Wound Drainage purulent: yellow, green, white, tan, thick and opaque
Wound Age Acute: new, making progress toward healing...uncomplicated surgical wounds
Wound Age Chronic: healing slow
stuck in the inflammatory stage
pressure ulcers, diabetic ulcers
Wound Depth partial thickness: heal quickly, involve only dermis, epidermis, painful
Wound Depth full thickness: penetrate though dermis and epidermis to underlying structure, slow to heal
Types of Dressings: dry, wet to dry, film, hydrogels, hydrocolloids, algimates, foams, imbedded
Hydrogels: gels or gelationous sheets, hight water content, good for a dry wound bed or sloughing wound with little drainage, requires secondary dressing like film- non absorbant
Hydrocolloids: for stage 1 or 2, flexible, not tramatic to the skin
Barrier cream: like diaper cream, keeps moisture,contaminates out
Alginates: made from seaweed, absorb huge amounts of fluid, require secondary dressing
Foams: used with wound vacs, dense, absorb moisture, insulates and maintains constant temp
imbedded: petroleum jelly like-scarlet red used for burns
montgomery straps: when patient requires frequent dressing but can't tolerate tape removal, tape plus lace up gauze...can last 2-3 weeks
Malpractice: negligence by a person performing as a professional and it must be proven
Intentional torts: include assult (threatening to touch), battery (touching), and false imprisonment
Informed consent: voluntary consent made by an INFORMED, competent client of legal age
Areas of Potential Liability for nurses are......: breach of contract
Invasion of privacy
Loss of client property
unprofessional conduct
Primary care providers' orders
recocord keeping
incident reports
giving aid to someone in distress (at scene of an accident)
Function of Law is to:: hold nurses to be accoutable, maintain standard of nursing practice

helps to differentiate nurse responsibilities from those of other health care professionals

it specifies what is legal for nurses to perform
Sources of Law: Constitutional: supreme law of the USA. It creates legal rights and responsibilities and is the foundation for a system of justice
Sources of Law: Legislation (STATUTES): Laws that are enacted by federal, state, and other legislation bodies (US Senate). If federal and state conflict...federal law prevails

Regulations of Nursing is provided by the state...That is the NURSE PRACTICE ACTS
Sources of Law: Common Law: These are laws that evolve from court decisions. Common Law is often used to resolve disputes between two parites, as in a law suit
Types of Law: Public Law: law between individuals and the goverment
Types of Law: Criminal Law: a type of public law, it deals with safety and welfare of the public (HOMICIDE, RAPE....)
Types of Law: Private (civil law): Law that deals with relationships between private persons
Types of Laws: Contract Law: Enforces agreements

If a contract is written it is considered expressed

An implied contract is a verbal or an understood responsibility in a specific relationship involving services one can expect to recieve from an individual in a job or role
Types of law: Tort Law: Defines duties and rights among individuals that are not based on contracts

Examples: nurse negligence, malpractice,invasion of privacy,assult and battery
Unintentional torts Negligence: practice that is below the standard expected of an ordinary, resonable, and prudent practitioner, placing another personat risk for harm
Unitentional torts Gross negligence: Extreme lack of knowledge or skill that the practicioner clearly should have known would place another at risk
Unintentional torts Malpractice: Negligence that occurs while the person is performing as a professional...it must be proven
Malpractice is proven by:: Nurse has a relationship with the client that involves providing care and is responsible for that patient

nurse did not observe standard of care that is expected

the cliet sustained harm, injury,or damage

The harm must have occured as a direct result of the nurses failure to observe the standard and the nurse should have known what was going to cause harm
Intentional torts Assult: an attempt to touch another person without justification....i.e Nurse says if you don't eat we will have to force feed you
Intentional tort Battery: Intentional touching of someone or something they are wearing. It would need to be a harmful touch, embarrassing, done without permission (continuing to bath after the client says NO!)
Informed consent Informed consent: consent is voluntary
the client was competent and of legal age
Client had enough information with which to make an informed choice
Nurse Practice Act: defines the scope of practice for the licensed nurse

protects the practice of nursing exclusively to the licensed nurse

protects the public by limiting the practice of nursing to the licensed nurse

legally controls the practice of nursing through requiered licensing
Accreditation: is the process which the state board of nursing or other private organizations, it evaluates and approves educational programs or services that meet predetermined criteria. All nursing school must be accredited by the state board of nursing
Florence Nightingale: Wrote Notes on Nursing, founder of modern nursing
Clara Barton: American Red Cross founder
Margaret Sanger: Public health nurse in NYC, Founder of Planned parenthood
Nursing is.....: promoting health and wellness

preventing illness

restoring health

care of the dying

client based
Nursing Process: Assessment: The nurse collects the patient health data
Diagnosis: the nurse analyzes the assessmnet date in determining diagnoses
Outcome: The nurse identifies expected outcomes individualized to the client
Planning and implmentation: the nurse develops a plan of care that prescribes interventions to attain expected outcomes and the nurse implements the plan of care
Evaluation: The nurse evaluates the patient's progress towards attainment of outcomes
Benner's stages of Nursing expertise: Novice= Stage 1: Stage 1: Novice..no experience, performance is limited, inflexible, and governed bycontext-free rules and regulations rather than experience
Benner's stages of nursing expertise: Stage II Advanced beginner: Demonstrates marginally acceptable performance, recognizes real experiences
Benner's Stages of Nursing expertise: StageIII Competent: Competent: has 2 or 3 years of experience, can plan organize, multi-task
Benner's Stages of Nursing expertise: StageIV Proficient: Proficient-3 to 5 years experience, long term goals, sees the big picture
Benner's Stages of Nursing expertise: Stage V Expert: Performance is fluid, highly proficient, take action because it felt right
Foods with phosphorus: milk
cheese
meat
egg yolks
Foods with Potassium: oranges
bananas
potatoes
brocoli
leafy greens
meat
nuts
legumes
Foods with Iodine: seafood
iodized salt
Foods with vitamin c: citrus
tomatoes
cabbage
sweet potatoes
green and yellow veggies
Foods with iron: liver
meat
seafoods
egg yolk
whole grain
legumes
green leafy veggies
Foods with calcium: whole grain
milk
cheese
green leafy
salmon
Foods with Vitamin D: yeast
fish oil
fortified milk
uv ray lights
Foods with Vitamn K: green leafy
cabbage
spinach
cauliflower
cheese
egg yolks
liver
Foods with Vitamin A: fish oils
liver
eggs
green and yellow veggies
cantaloupe
watermelon
peaches
fortified milk
Protein Sources: eggs
milk
fish
milk
poultry
nuts
legumes
soy proteins
Carb Sources: grains
potatoes
corn
peas
fruits
sugar
Fat soluble vitamins: A,D,E,K
Water soluble vitamins: C,B
Lipoprotiens: Compound lipids
HDL=good
LDL=bad
complete proteins: provides all 9 essential amino acid in sufficient amounts for body. Animal products and soy
Incomplete protein: lack at least one of the essential amino acids

Plant sources Except soy
Complimentary Proteins: two incomplete protiend that together make up all nine-this is how veggie survive i.e. peanut butter and whole grain bread
Bronchi sounds: low pitched gurgling as the large airways fill with air
Crackles Sounds: fine,coarse, popping as air passes through the fluid in the small airways
Wheezes Sounds: high pitched whistling as air passes through narrowed passage ways
Friction Rub Sounds: grating or scratching as the inflamed pleura rubs
kyphosis: hunchback
lordosis: swayback
Six links in the chain of infection: etiologic agent
reservoir
portal of exit
method of transmission
portal of entry to a susceptable host
susceptible host
Signs and symptoms of localized infection are:: fever
malaise
leukocyte count>than 11,000/cu mm
enlarged lymph nodes
anorexia
nausea/vomiting
What happens when you encounter stress: there is a release of epinephrine and cortison with subsequent changes in the organ systems
Aldosterone: is released from the adrenal cortex, sodium and water are reabsorbed in greater quantities increasing the blood volume and decreasing the urinary output
signs and symptoms of stress: dialated pupils
diaphoresis
increased heart rate
increased sodium and water retention...resulting in increased blood volume and increased cardiac output
increased rate of respirations and depth (hyperventilation)
skin pallor
decrease urinary output
dry mouth
decrease peristalsis, resulting in flatus and contriction
improved mental alertness
increased muscle tension
increased blood sugar
psychological signs and symptoms of stress: anxiety
fear
anger
depression
unconscious ego defenses i.e.
denial
displacement
projection
rationalization
regression
sublimination
normal grief: crying,sleep disturbances,loss of appetite,difficulty concentrating,fatigue
dysfunctional grief: severe physiological symptoms
suicidal thoughts
extended periods of grief
prolonged time in stage of denial
prolonged or severe social isolation
persistent guilt
low self-esteem
drug abuse
Kubler-Ross stages of dying and grieving: Denial,Anger,Bargaining,depression,acceptance
Gate control theory: pain impulses can be blocked by a gate between transmission cells in the dorsal horn of the spinal cord.There is a block of too much infromation to the nerves and it could involve distraction mechanisims
The Body's Analgesia system: when regions of the midbrain are stimulated and endorphin opiods are released

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